**Background to the Universal Health Visitng Pathway in Scotland**
The Scottish Child Health Programme was initially set out in the ‘Health for All Children 4’ (Hall 4) policy implementation for Scotland in 2005 with the aim of providing proactive care and support of children to help them attain their developmental potential (Scottish Executive, 2005). This policy was based on the Royal College of Paediatrics and Child Health review of child health screening and surveillance, published in 2003. Hall 4 signified a move away from a medical model of screening for disorders, towards a greater emphasis on health promotion, primary prevention and particularly targeting families deemed to be ‘at risk’ for intervention. The main body of this program contained universal checks at key points, alongside the allocation of a Health Plan Indicator (HPI) at the 6-8 week check, which dictated whether the family required more frequent health visitor input, or no health visitor input, unless requested by the family. However, following the introduction of Hall 4, concerns were raised that HPI allocation at 6-8weeks was not adequately identifying children with future difficulties, and some of these children who went on to be developmentally delayed, were not coming to the attention of health services in a timely manner. A refresh of the programme in 2010, reintroduced a universal review at 24-30 months, as well as developing further guidance on the program’s implementation and committing to a review of the associated Child Health Surveillance Programme (preschool) (CHSP-PS) (Scottish Government, 2010).
In order to introduce the 24-30 month review, a short-life working group was set up in late 2011 to produce national guidance on its content and delivery. A key recommendation from this group was that there was too much variability in development at 24 months, and thus the ‘new’ universal check should be implemented from 27 months, with the aim that all reviews are completed by 30 months. The review was to be offered to all children, regardless of HPI, and intended to promote strong early child development, particularly focussing on social, emotional, language and cognitive development, within the context of wider family wellbeing and ‘helpful parenting’ (Scottish Government, 2012) .
Alongside these policy developments was the introduction of Getting It Right for Every Child (GIRFEC) in 2006. GIRFEC is based on children’s rights and aims to support families by ensuring that children get the right help at the right time from the right people. It covers health, but also education and other professionals. The key principles are that it is child-focussed; based on an understanding of the child in their current situation; is based on tackling needs early; and requires joined up working (Scottish Government, 2019).
In 2015, additional national guidance on the delivery of Hall 4 was launched, entitled the Universal Health Visiting Pathway (UHVP). Incorporating GIRFEC and the learning from health visiting and programmes such as the Family Nurse Partnership, the UHVP had a renewed focus on intensive intervention in the infancy period, along with an increase in the universal visits received by all families. The policy document states that fundamental to these changes were ‘the utilisation of public health approaches in responding to all families; an emphasis on reducing inequalities by increasing access to appropriate interventions; responding to vulnerable groups and importantly, ensuring that the right number of Health Visitors are in the right place, with the right support available to them to enhance their professional practice.’ The UHVP comprises 11 home visits to all families - 8 within the first year of life. Five of these are universally offered formal child health reviews (at first visit, 6-8 weeks, 13-15 months, 27-30 months and 4-5 years).
The pathway is based on several underlying principles. These are:
Promoting, supporting and safeguarding the wellbeing of children
Person-centeredness
Building strong relationships from pregnancy
Offering support during the early weeks and planning future contacts with families
Focusing on family strengths, while assessing and respectfully responding to their needs.
In 2014, it was estimated that there were 1,114.7 Whole Time Equivalent Health Visitors in post. It was intended that around 500 additional health visitors would be recruited across Scotland to support the delivery of the new universal pathway.
The Scottish Government has commissioned a national evaluation of the UHVP. The evaluation will run from July 2018 to Dec 2022. It will evaluate both the implementation of the UHVP (process evaluation) and its impact on children’s outcomes (outcome evaluation). It will do this using routine data, a case note review, qualitative interviews and a quantitative survey. The project will be delivered over 2 key phases, with interim results released at the end of Phase 1 (all reports due by end Jun 2020) and final results at the end of Phase 2 (all reports due by end Sep 2022).
This OSF page documents the routine data element of the evaluation; that is, the section that explores national and local data collected routinely through health and education records.**strong text**
